Winter Camp Permission Slip

EVERYONE IS GOING SLEDDING ON SUNDAY! PLEASE PICK YOUR ACTIVITY FOR SATURDAY Lift Ticket Youth (12 and under): Teen (13-19): Rentals (does NOT include lift ticket) Youth Ski (12 and under): Youth Snowboard (12 and under): Teen Ski (13 and up): Teen Snowboard (13 and up): Learning Packages (includes lesson, rental, and LIMITED lift) Youth Ski (12 and under): Youth Snowboard (12 and under): Teen Ski (13 and up): Teen Snowboard (13 and up):

Check all that apply

Just Hang Out At The Dodge Ridge Ski Lodge

___ $16 ___ $41 ___ $28 ___ $38 ___ $28 ___ $38 ___ $79 ___ $79 ___ $79 ___ $79 ___ Free

Cost of Sunday Activities $___ + Camp Base Cost - $215

(includes lodging, meals & Sunday Sledding

$_____

= Your Total Cost $____

WINTER CAMP DETAILS REGISTRATION PACKET CHECK LIST 1. SVCC Permission Slip 2. 2006-2007 SVCC Emergency Card 3. Dodge Ridge Forms (will reciever after sign up) TRIP INFO Deadline To Sign Up: January 11 All Money Is Due: January 16 Departure- Friday, January 16, 2009, 12:30pm We meet at 12:30pm at South Valley Community Church. When you arrive, unload your luggage, and proceed to the sign in tables. We can’t leave the parking lot until all students have checked in. Arrival- Monday, January 19, 2008, 3:00pm We will arrive at South Valley Community Church at approximately 3:00pm You can call 408.8482363 ext. 106 after 1:00pm for an update arrival time. Emergency Numbers Steve Gold, Jr. High Pastor, 408.691.5362 Silver Spur Christian Camp, 209.928-4248 Questions? Call Steve at 408.848.2363 ext.106

Winter Camp Pemission Slip 2009 Junior High Ministry • South Valley Community Church 8095 Kelton Dr. • 408.848.2363 www.svccyouth.com

Student Name: ________________________ Phone Number: _________________ Address: ________________________________________ City: _____________ State: ___ Zip: _________ Grade :____________ School: _____________________________ Join our e-mail list? __________________________________@____________________ . _______ Do you have an emergency card on file(You MUST have one on file to come with us)?  Payment:

$_________

 Cash

YES  NO (flip over and fill out back)

 Check #________

While South Valley Community Church makes every effort to provide a safe and pleasant environment for your child, we do require that this participation agreement be read, filled out, signed and dated by the parent or legal guardian of each child under 18 years of age who wishes to participate in the activities which occur with South Valley Community Church. I, the undersigned, give permission for my son or daughter to participate in the activities that occur at WINTER CAMP These activities include, but are not limited to, EATING FOOD, SKIING, SNOWBOARDING, SLEDDING, HANING OUT WITH FRIENDS, RIDING IN A CAR WITH OTHER PEOPLE on the dates of JANUARY 16-19, 2009. I grant this permission with full knowledge that I accept full responsibility for any injury or accident that may occur. I, on behalf of myself, my children, my assigns and my estate, agree to release and hold harmless South Valley Community Church, its officers, Board, agents or employees, for any and all claims for injuries, causes of action, or liability related to my child’s participation in any activity occurring with South Valley Community Church. The release does not apply to intentional and/or willful acts of misconduct by South Valley Community Church or any of its officers, Board, agents or employees. By signing this document, I acknowledge that if anyone is hurt or property damaged during my child’s participation in this activity, I and/or my child may be found by a court of law to have waived any right to maintain a lawsuit against South Valley Community Church on the basis of any claim which has been released herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agreed to be bound by its terms.

Parent Name __________________________________

Signature___________________________ Date ___ / ___ / 2009

Junior High Ministry Emergency Card • 2008-2009 South Valley Community Church •8905 Kelton Dr., Gilroy, CA 95020 • 408.848.2363

Please Print Clearly!

Student’s Name ______________________________________________________________

First



 Male

 Female

Last

Address_ _______________________________________ City___________________________ Zip________________ Home Phone #______________________________________ Birth Date______ /_____ /______ Grade in Fall 2008 _ ______ School_ ______________________ Student’s E-Mail Address___________________________________________________ Allergies or Other Concerns?______________________________________________________________________________ Dad’s Name:_______________________________________ Cell/Pager #_________________ Work #________________

First

Last

Mom’s Name:_ _____________________________________ Cell/Pager #_________________ Work #________________

First

Student Lives With:

Last

 Both parents

 Dad

 Mom

 Other:______________________________

AUTHORIZATION OF CONSENT FOR TREATMENT OF A MINOR

(I)(We), the undersigned, parent(s) guardian(s) of do hereby authorize an official of South Valley Community Church to act as designee for the reverse named minor to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is prescribed by, and is to be rendered under the special supervision of, any licensed physician/or surgeon, whether such diagnosis or treatment is rendered at the office of said physician/surgeon or at a hospital or elsewhere. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being rendered and is given to provide authority and power on the part of our aforesaid designee to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician/surgeon may, for reasons he/she deems appropriate, prescribe. (I)(We), hereby authorize any hospital that has provided treatment to the above named minor to surrender physical custody of such minor to (my) (our) named designee(s) upon completion of treatment. This authorization is given for designee(s) for those times that (I) (We) cannot be reached by telephone at home or work at the numbers listed below. This authorization is not to be construed as releasing any physician or surgeon from any requirement that he or she adhere to the lawful standard of care in attending to the named minor and is not to be construed as creating any financial responsibility on the part of South Valley Community Church or the respective directors, officers, employees and agents as well as named officials thereof for any health care provided the named minor. PARENTS ARE RESPONSIBLE FOR PAYMENT. This Authorization to Consent to Treatment of a Minor shall be in full effect for the date range of June 2008 to May 2009.

Parent/Guardian Signature_______________________________________________________ Date___________________ In case of emergency when neither parent can be reached, please notify: Name Address Phone Relationship to Student 1)____________________________ ____________________________ _ _______________ _____________________ 2)____________________________ ____________________________ _ _______________ _____________________

Name of Insurance Company__________________________ Group #_____________ Policy #____________

Winter Camp 2009 Packing List To Bring: • • • • • • • • • • • • • • • • • • • • • • • •

• •

Sleeping bag Camera (optional) Comfortable clothing for hanging out at camp, and the ride up All toiletries, towel Lots of extra warm socks (wool or ski, not cotton if you can) Extra changes of clothes Pillow Thermal tights/underwear Water proof or water resistant pants Gloves / mittens (2 pair) Lip balm Warm clothes (sweatshirt/jacket) Layering is a good idea, with a water proof jacket and pants on the outside Sunscreen SPF 15 or higher Warm hat/headband Sunglasses (optional) Goggles (optional) $$ for a snacks and 2 lunches Bible Pen and notebook Snowboard or skis Games/cards to play at Dodge Ridge SNOWBOOTS Plastic garbage bags for sleeping bags and pillows (Bring enough for the way up and the way back. You WILL need these unless you like sleeping in a wet sleeping bag!) Smiles and a sense of humor Patience for the ride

What NOT to bring!!!!! • • • • • • • • •

Cell Phones CD/Tape Player Weapons Computers Illegal drugs Alcohol Fireworks Electronic devices Gameboys

To Avoid When Skiing or Sledding:

Avoid cotton clothing while skiing/ snowboarding/tubing, because it doesn’t keep you warm. Jeans, leather, and sweatshirts are not good either because they do not have any insulation from the snow.

Remember While Packing: • •

•

Bring anything to keep you warm! You MUST Label ALL your belongings! It’s easy for things to get mixed up- especially if everyone puts their belongings in garbage bags! You are responsible for any equipment you own or rent here in Gilroy. Generally the policy is: You bring it, you lose it, you pay for it! Be careful!